Provider Demographics
NPI:1932429347
Name:WILSON, LORI ANN (RESPIRATORY THERAPY)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RESPIRATORY THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 PINEVILLE MATTHEWS ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-542-4800
Mailing Address - Fax:704-542-4808
Practice Address - Street 1:7108 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8187
Practice Address - Country:US
Practice Address - Phone:704-542-4800
Practice Address - Fax:704-542-4808
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-4340227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified